Impact of age on early outcome after coronary bypass graft surgery using minimized versus conventional extracorporeal circulation

Abstract

BackgroundObjective of this study was to evaluate the impact of age on comparative early outcomes after coronary artery bypass graft surgery (CABG) with minimized (MECC) and conventional extracorporeal circulation (CECC).MethodsA retrospective age-, gender- and operation-matched cohort analysis between January 2005 and December 2010 with a total of 2274 patients undergoing CABG with MECC (n = 1137; 50%) or CECC was performed. Patients were stratified into 4 groups according to age: <59 years, 60–69 years, 70–79 years, and 80 years of age or older. Outcomes were compared within each age group. Patients with preoperative dialysis were excluded from analysis. Primary endpoint was 30-day mortality.ResultsPatients treated with CECC had a significantly higher mean logistic EuroSCORE (6.3% vs. 5.0%; p < 0.001), a slightly lower rate of preoperative myocardial infarction (46% vs. 51%; p = 0.01) and a higher rate of impaired renal function (eGFR < 60 mL/min/1.73 m2: 24% vs. 20%; p = 0.01) compared to MECC-patients. Left internal mammary artery was significantly used more often in MECC patients (93% vs. 86%; p < 0.001). Cardiopulmonary bypass and aortic-cross clamping time were significantly lower in the MECC group (p < 0.001). Overall 30-day mortality was significantly higher in patients treated with CECC (4.4% vs. 2.2%; p = 0.002). Within the different age groups mortality rates were not significantly different except for patients aged 60–69 years (4.5% vs. 1.8%; p = 0.03). Postoperative requirement of renal replacement therapy (4% vs. 2.2%; p = 0.01), respiratory insufficiency (9.9% vs. 6.6%; P = 0.004) and incidence of low cardiac output syndrome (3% vs. 1.2%; p = 0.003) were significantly increased in patients with CECC. Multivariate analysis identified age (p = 0.005; 95% CI 1.01 to 1.08; OR 1.05) among other parameters as an independent risk factor, whereas conventional extracorporeal circulation itself did not present as an independent risk factor for 30-day mortality.ConclusionsIn this matched study sample early outcome was significantly better in patients with MECC compared to CECC, irrespective of age. Prior myocardial infarction estimated GFR < 60 mL and waiving the use of LIMA were independent risk factors for 30-day mortality, which were more present in the CECC group.

Nursing Evaluation of Risk Factors Associated with Surgical Site Infection Among Coronary Artery Bypass Graft Patients at King Abdulaziz University Hospital

“…For this study, the infected cases were 20% while non-infected cases were 1%. These findings support those of study in 2014indicate that 3% of coronary artery bypass graft patients exhibit low cardiac output syndrome [45]. Low cardiac output affects a much higher percentage (13.5%) of patients undergoing coronary artery bypass graft surgery with old age, impaired left ventricular function, and emergence and incomplete revascularization being independent risk factors [46].…”

Minimized extracorporeal circulation is improving outcome of coronary artery bypass surgery in the elderly

“…A previous analysis of younger patients identified duration of CPB, cross-clamp time, AKI and preoperative myocardial infarction as independent risk factors. 16 These results allow us to suggest that MECC is not only a safe, but also a superior alternative for CABG in elderly patients compared to CECC. Possible explanations for better results with MECC have been discussed in detail by prior authors.…”

Coronary Artery Bypass Grafting with Arterial Conduits in the Elderly

“…Moreover, selective use of off-pump CABG (OPCABG) and minimized extracorporeal circulation systems in this high-risk population can reduce multiorgan morbidity and post-operative systemic inflammatory response syndrome. 8,12,[48][49][50][51] However a retrospective analysis of the results of the Australian and New Zealand Society of Cardiac and Thoracic Surgeons' (ANZSCTS) database for elderly patients 52) undergoing isolated CABG surgery compared the on-pump coronary artery bypass (ONCABG) (n = 11676) with OPCABG (n = 1021) technique. The authors showed that high-risk patients were more prevalent in the ONCAB group.…”

“…However, improvements in technical management, particularly the development of innovative extracorporeal circulatory systems, the use of off-pump CABG and the increased use of pedicled arterial conduits have been proven effective in improving outcomes, although they have not completely eliminated the morbidity in this high-risk population. [8][9][10][11][12][13][14] Although improved long-term outcomes obtained with the use of arterial grafts for coronary revascularization in comparison with the traditional association of a single arterial and saphenous vein grafts have been demonstrated in the overall population, 15) the efficacy of this newer technique in the elderly remains difficult to verify because their shorter life expectancy due to advanced heart disease, associated with severe comorbidities. [16][17][18][19][20][21] Moreover more widespread use of this technique is limited by concerns on the potential morbidity, particularly the longer time required to perform the operation and the possibility of deep sternal wound infection in case of bilateral internal thoracic artery harvesting due to the deFrom the…”